On “Is the BESTest at its best?….” Padgett PK, Jacobs JV, Kasser SL. Phys Ther. 2012;92:1197–1207.

Abstract

Padgett et al explained the necessity of a new shortened version of BESTest, different from the Mini- BESTest, on the basis of anecdotal reports suggesting that the latter remains too lengthy (about 15 minutes) given increasing constraints on patient contact time in the clinic.1 Moreover, the authors felt the lack of a scale more in line with the theoretical objective of the BESTest, which is to provide a global assessment of multiple constructs that influence postural control. [...]the authors created the Brief-BESTest, selecting the "most representative item" in each of the 6 balance domains listed in BESTest,2 based on item-total correlation.1 Although conceptually appealing, choosing only 1 item to cover each "domain" of postural control-as interpreted by the BESTest2-may be psychometrically unsound and needs to be strongly justified, as even in a short questionnaire 3 or more items usually are needed to define a construct or dimension4 (eg, as in the BESTest), especially if the new scale must be able to inform clinicians "to direct interventions on the basis of these impairments. [...]all of these findings compare unfavorably with the Mini-BESTest, suggesting, at best, the need for further, more sophisticated analysis to develop alternate short forms of the BESTest. Lastly, Franchignoni and Giordano highlight our third question posed above regarding whether items that represent mechanical constraints and limits of stability improve the diagnostic value of the Brief-BESTest.